RESUMO
Aortic repair for severely atheromatous aneurysm remains a challenge. We used an intermittent clamp technique for all visceral arteries during thoracic endovascular aortic repair (TEVAR) for a thoracic aortic aneurysm with a "shaggy aorta" to prevent systemic thromboembolism. In addition, we applied an extracorporeal circulation circuit to trap the thrombi during the endovascular repair. Postoperatively, no embolic complications were seen, and microscopic examination showed trapped plaques on the filter. We conclude that this technique is an option for preventing thromboembolism in aortic aneurysm repair in the context of a shaggy aorta when substantial concern of distal diffuse atheromatous emboli is raised based on clinical history or clear evidence on imaging.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Aterosclerose/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Vísceras/irrigação sanguínea , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aterosclerose/complicações , Aterosclerose/diagnóstico , Implante de Prótese Vascular/efeitos adversos , Colectomia , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Constrição , Procedimentos Endovasculares/efeitos adversos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
An 82-year-old man with asthma and chronic obstructive pulmonary disease experienced sudden back pain. Chest computed tomography (CT) showed a thoracic aortic aneurysm (TAA) 63 mm in maximum diameter, with severe atheromas, representing "shaggy aorta", extending down to the level of the ninth thoracic vertebra. Emergency surgery was necessitated by the impending rupture of the aneurysm. The patient underwent successful total arch replacement with open-stent grafting using a GORE(®) TAG(®) thoracic endoprosthesis. His postoperative course was uneventful and there were no neurological complications. We discuss the advantages and disadvantages of using the GORE TAG system for an open-stent graft.
Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Placa Aterosclerótica/cirurgia , Stents , Idoso de 80 Anos ou mais , Emergências , Humanos , Masculino , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
We describe a simple technique of introducing intracoronary shunts for off-pump coronary artery bypass. This technique, with an aid of micro-bulldog clamp, provides both a test clamp with ischemic preconditioning effect, and a quick and easy introduction of intracoronary shunt, giving a clear visualization of coronary anastomosis site and distal coronary artery perfusion. We recommend this technique as another effective modality in off-pump coronary artery bypass surgery.